Extremely Wide and Asymmetric Anterior Decompression Causes Postoperative C5 Palsy

Odate, Seiichi; Shikata, Jitsuhiko; Yamamura, Satoru; Soeda, Tsunemitsu

doi:10.1097/brs.0000000000000019

Cited by 36 publications

(38 citation statements)

References 16 publications

(1 reference statement)

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“…found that 32 (7%) experienced postoperative C5 palsies [Tables 1 and 2 ]. [ 18 ] They were divided into two groups (palsy side [ n = 35] and nonpalsy side [ n = 29]), and their clinical/radiographic studies were compared with 66 consecutive other patients who had the same procedures without C5 root deficits. They found that those with C5 palsies had smaller preoperative C4-C5 foramina, underwent more extensive/wider/asymmetric unilateral decompressions, and exhibited less anterior spinal cord shift.…”

Section: Risk Of C5 Palsy With Anterior Cervical Decompressionmentioning

confidence: 99%

C5 Nerve root palsies following cervical spine surgery: A review

Epstein¹,

Hollingsworth²

2015

Surg Neurol Int

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Background:Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3–24 postoperative months.Methods:Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF).Results:Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies.Conclusions:The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0–30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.

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Section: Risk Of C5 Palsy With Anterior Cervical Decompressionmentioning

confidence: 99%

C5 Nerve root palsies following cervical spine surgery: A review

Epstein¹,

Hollingsworth²

2015

Surg Neurol Int

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“…The incidence of this complication has been reported to be between 0% and 30% depending on procedure type and approach. 1-36 Patients commonly present with new weakness in the deltoid and/or biceps brachii, sensory deficits, and/or pain in the shoulders, and dissatisfaction with surgery *. C5 palsy may present immediately after surgery or up to 2 months postoperatively † and can negatively affect postoperative quality of life in the short term.…”

Section: Introductionmentioning

confidence: 99%

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases

Thompson

Smith

Hsu

et al. 2017

Global Spine Journal

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Study Design:A multicenter, retrospective review of C5 palsy after cervical spine surgery.Objective:Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.Methods:We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ2 tests or Fisher exact tests for categorical variables.Results:Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%).Conclusion:C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

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“…In regard to the C4/5 foraminal stenosis, the mean diameters of C4/5 foramen with C5 palsy were reported below 2.7 mm [2–4]; however, that of this patient was 3.5 mm. No left C4/5 foraminal stenosis in the intraoperative findings also supports the spinal cord lesion responsible for C5 palsy.…”

Section: Discussionmentioning

confidence: 86%

“…Although the nerve root tethering produced by spinal cord shifting after spinal cord decompressive surgery is now becoming a leading hypothesis [2–4], the cause of C5 palsy is still controversial and the spinal cord lesion is also hypothesized as the probable mechanism [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

A Delayed Postoperative C5 Palsy due to Spinal Cord Lesion: A Typical Clinical Presentation but Unusual Imaging Findings

Tadokoro

Kasai

Kiyasu

et al. 2016

Case Reports in Orthopedics

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Postoperative C5 palsy (C5 palsy) is a troublesome complication after cervical spine surgery and its etiology is still unclear. We experienced a case of C5 palsy after anterior decompression with fusion for cervical ossification of posterior longitudinal ligament with the typical clinical presentation of left deltoid and bicep weakness and left-arm pain without deterioration of myelopathy symptoms, albeit with the unusual imaging findings not shown preoperatively of a swelling in the spinal cord, and intramedullary high intensity change on T2-weighed MRI. The additional posterior surgery was carried out to decompress the swollen spinal cord. The abnormal findings disappear on MRI taken three weeks following the second surgery and the weakness improved fully within three months after the second surgery. This case report highlights the possibility of spinal cord lesion due to circulatory impairment as a cause of C5 palsy.

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Extremely Wide and Asymmetric Anterior Decompression Causes Postoperative C5 Palsy

Cited by 36 publications

References 16 publications

C5 Nerve root palsies following cervical spine surgery: A review

C5 Nerve root palsies following cervical spine surgery: A review

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases

A Delayed Postoperative C5 Palsy due to Spinal Cord Lesion: A Typical Clinical Presentation but Unusual Imaging Findings

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